Activate Awesome! The Power of Behavioural Activation.

Hi, my name is Dr Kate Haywood. I am a family physician with an interest in mental health and I have recently moved to Imagine Health Centres. Dr McKay has asked me to write a piece on behavioural activation for this month’s article. This is a psychological  technique commonly used to treat depression and anxiety, but I think that approach can be very useful from the perspective of self-care and promoting good mental health for everyone.

The idea sounds very simple and comes from the fact that a common response to stressful situations and the fatigue that this brings, is to try to rest and reduce your activities. Unfortunately, this can result in worsening mood and set you up for a downward spiral resulting in depression and anxiety. As your mood drops, so does your hope that things can improve, your imagination as to what options are available and your motivation to do anything about it. So whilst it may seem like common sense, sometimes it can be easier said than done. 

I come at this from personal experience. 11 years ago I experienced a significant bout of depression. At this time I was already a family physician.  As part of my training in the UK, I had worked as a junior doctor in psychiatry, so I knew about the principles of treatment. However, this training had not prepared me for what being depressed would actually feel like. The idea of just trying to do more things seemed very vague and not very helpful. I was already running 3 times a week and making time to see friends, so what else was I supposed to do?

In the end I fell upon the idea of breaking self-care/behavioural activation into 3 parts and have been using this approach for myself and my patients ever since. The idea is that in the morning you pick an activity from each group that you promise yourself that you will do that day:

“Something that needs to be done”. How hard this needs to be depends on what sort of day you are having, it should be something that requires a bit of emotional effort to achieve. On a bad day this can simply be doing a load of washing or telephoning to book an appointment, on a better day this could be doing part of your tax return or updating your resume. For big projects, break them down into smaller sections that are manageable. The idea is that at the end of the day your list of things that you need to do is slightly shorter or even if things have been added to it, the list is not just growing inexorably. This helps improve your self esteem and the feeling that you do have some control over what is happening to you.

“Something that is good for your mental health”. There are a whole group of things that we know are good for mental health e.g. physical activity, meditation, creativity, helping others, being in nature and social connection. A good idea is to look at something that you do not do as part of your job or regular activities, if you are a homemaker, carer or are retired. If you have a physically demanding job then a relaxing meditation might be a good pick.  If you spend much of your day working at your computer, then doing your favourite physical activity, be it a walk, lifting weights at the gym or a zumba or yoga class is likely to be beneficial. If you can combine two activities that is even better e.g. going for a walk with a friend and/or head out to Fish Creek Park.

“Something that is a treat”. By this I mean something that brings you joy or at least pleasure. It can often be something that you don’t always make time for. Examples of this can be having a bath with bath salts or candles, reading a novel or enjoying a nice hot drink whilst listening to music. The fact you are a member of this group suggests that you are working on your weight, so I don’t particularly want to be recommending food as the daily treat. Saying that, if you have been well with your weight loss and wish to reward yourself, then food can be part of this. The only thing is whatever you pick, make sure to try to savour the experience. Think of all your senses in detail with whatever you are doing. For example, when you are making the hot drink, listen to the sound of the liquid dripping or pouring into your cup. Feel the warmth of the cup through your hands. Smell the drink before you take a sip.The treat does not have to take a long time. It may only be 5 minutes, but the point is that it is intentional and that you are demonstrating to yourself that you are worthy of care. There have been occasions where I have “treated” myself, by putting on some of my favourite music whilst cooking dinner and singing and dancing around the kitchen, much to my kids’ embarrassment. If you don’t feel any pleasure when you are experiencing your treat, please speak to a physician about this. It could be a sign that you have significant depression which needs proactive treatment. (Saying that if it was a chocolate bar and you have been eating healthily for a while, it could be simply that your tastes have changed, so don’t panic just try something different!)

If you have time and energy for more than one thing from each group then go for it! Also life happens and flexibility is important. If you had planned to head out to the gym, but your friend phones and suggests going out for a coffee then, as long as they are the type of friend who is good for your mental health, make time for the coffee ( this could be your treat), just consider asking them if they’d like to go for a walk with the coffee rather than just sitting and chatting.

Best wishes as you work toward the future.